How far are the ‘left behind’ left behind? The psychological and physical wellbeing of family members of international labour migrants.

1Health Unit, International Organization for Migration, Sri Lanka, Sri Lanka, 2Institute of Psychiatry, King's College London, United Kingdom, United Kingdom.

Country - ies of focus

Sri Lanka

Relevant to the conference tracks

Governance and Policies

Summary

International labor migration has become a crucial engine in economic development for many countries worldwide. Even though the enormous contribution from international migrant workers to Sri Lanka’s economic development is well documented, politically encouraged, socially accepted and commercially stimulated, little is known on the actual health and social consequences of the ‘left behind’ members of their families. Despite the growing importance on migration for global development, the public health implications for migrants and their families have received little attention and empirical research into measuring impacts have been scarce.

Background

ILM from Sri Lanka has grown ten-fold during the past decade, with 23.8% of Sri Lanka’s total labour force currently employed abroad. In what was once a highly feminized labor force, today 49% percent of ILMs are women, and out of these, 86% are ‘domestic housemaids’ with the majority (over 93%) employed in the Middle Eastern countries. ILMs contributed 4.1bn USD to the Sri Lankan economy in 2011 (second highest contributor). Many ILMs also choose continuous cycles of re-migration (‘circular migration’) to increase their savings potential. Even though the enormous contribution from international migrant workers to Sri Lanka’s economic development is well documented, politically encouraged, socially accepted and commercially stimulated, little is known on the actual health status and health consequences of the ‘left behind’ members of their families. The WHA resolution on health of migrants prompted public health attention and called for an evidence-based research agenda on migration health. In the current study, the association of spousal migration with socio-demographic factors and health status of ‘left-behind’ family members (spouse, children and care givers) were compared with families without a history of migration, using standardized instruments with diagnostic values.

Objectives

Despite the fact that nearly one-in-ten Sri Lankans are employed abroad as International Labor Migrants, very little is known about the impact of their migration on the health status of the families they ‘leave behind’. The findings from this study will be useful to form an evidence-based approach in the National Migration Health Policy for Sri Lanka. In addressing the social and health impacts and determinants on the reliance for migration for development the challenge for policy makers lies at the nexus of migrant rights and economic gain through remittances and responsibility. In order to advocate for migrant sensitive health policies, empirical evidence is needed to determine the true health consequences of labour migration on families 'left behind'.

Methodology

This national study utilized both quantitative and qualitative methods to study associations between the health status of ‘left-behind’ spouses, children and caregivers, and comparative non-migrant families. A cross-sectional study design with multi-stage random sampling was used. We surveyed a total of 1990 persons; 875 adults (from 410 migrant and 410 non-migrant families), 820 children from 410 migrant and 410 non-migrant families matched for both age and sex, and 295 school teachers linked to these children. Socio-demographic and health status data were derived using standardized pre-validated instruments. Univariate and multivariate analyses were used.

Results

Nearly one-in-three migrant families were from single-parent households. Forty-four percent of left-behind children had some form of psychopathology, with over a quarter of those under 5-years being underweight or severely underweight (29%). Association of emotional, hyperactivity, conduct problems and having any psychiatric diagnosis was strongest in children from migrant family households [Odds ratio 1.62 (CI: 1.16-2.27)], and was exacerbated in families where the sole parent was the overseas based migrant worker. Significantly high levels of depression were found in caregivers [12.3% (CI: 12.23-12.31)] and spouses from left-behind families [25.5% (CI:25.47-25.60], with physical health status showing similar trends.

Conclusion

Findings provide empirical evidence on the health consequences for heavy out-migration for the families ‘left-behind’. These are relevant for many labour ‘sending countries’ in Asia relying on ILM remittances. Whilst cross-sectional studies can only suggest, but not prove a cause–effect relation, this study highlights a number of major challenges for policy makers at the nexus of balancing rights, remittances and health consequences. We advocate the adaptation of migrant sensitive health policy frameworks guided by the 2008 World Health Assembly Health of Migrants Resolution, which promotes safe, healthy and economically beneficial ‘migration for all’.